Sensorimotor Balance Training for Chronic Nonspecific Low Back Pain

Chronic nonspecific low back pain (CNSLBP) is a major cause of disability and reduced quality of life worldwide. In addition to pain, individuals with CNSLBP frequently demonstrate impairments in sensorimotor control, proprioception, postural stability, and trunk muscle coordination. These impairments may contribute to persistent symptoms and functional limitations.

Sensorimotor balance training has emerged as a rehabilitation approach aimed at improving sensory integration, neuromuscular control, and dynamic postural stability. Previous studies have reported beneficial effects of sensorimotor-focused interventions on pain and functional outcomes; however, most investigations have relied primarily on self-reported measures, with limited assessment of objective biomechanical changes.

The DIERS Formetric 4D system provides a non-invasive, radiation-free method for evaluating spinal posture and alignment, including measures of trunk imbalance, pelvic tilt, and sagittal spinal curvature. The integration of objective spinal assessment with rehabilitation interventions may provide greater insight into the relationship between symptom improvement and structural-functional adaptations.

This randomized controlled trial aims to evaluate the effects of sensorimotor balance training on pain intensity and spinal alignment in adults with chronic nonspecific low back pain. The study will compare sensorimotor balance training with standard physiotherapy and examine whether improvements in pain are associated with measurable changes in spinal alignment. Findings from this study may contribute to the development of evidence-based rehabilitation strategies for the management of chronic nonspecific low back pain.

• Sensorimotor Balance Training (Behavioral): Participants will receive a structured sensorimotor balance training program designed to improve proprioception, postural stability, and neuromuscular control. The intervention will be delivered three times per week for 12 weeks, with each session lasting approximately 45 minutes. Exercises include wobble board balance training, core activation exercises, and dynamic single-leg stance activities. Exercise difficulty will be progressively increased every two weeks according to participant performance and
• Standard Physiotherapy (Behavioral): Participants will receive standard physiotherapy treatment consisting of stretching and core strengthening exercises. The intervention will be delivered three times per week for 12 weeks, with each session lasting approximately 45 minutes. A standardized progression protocol will be followed throughout the intervention period to ensure consistency of treatment delivery across participants.

Primary outcomes

• Pain Intensity Measured by the Numeric Pain Rating Scale (NPRS) [Baseline and Week 12]: The Numeric Pain Rating Scale (NPRS) is a self-reported measure of pain intensity scored from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. The primary outcome will be the change in pain intensity from baseline to the end of the 12-week intervention period.
• Spinal Alignment Measured by DIERS Formetric 4D [Baseline and Week 12]: Spinal alignment will be assessed using the DIERS Formetric 4D system, a non-invasive and radiation-free surface topography method. Parameters evaluated will include trunk imbalance, pelvic tilt, and sagittal spinal curvature. The outcome measure will be the change in spinal alignment parameters from baseline to the end of the intervention period.

Secondary outcomes

• Functional Disability Measured by the Oswestry Disability Index (ODI) [Baseline and Week 12]: Functional disability will be assessed using the Oswestry Disability Index (ODI), a validated questionnaire measuring the impact of low back pain on daily activities and functional performance. The outcome measure will be the change in ODI score from baseline to the end of the 12-week intervention period.

Sex: All, ages: 18 Years to 59 Years

Inclusion Criteria:

* Adults aged 18 to 59 years. Diagnosis of chronic nonspecific low back pain lasting at least 3 months. Pain intensity score of 4 or greater on the Numeric Pain Rating Scale (NPRS). Body Mass Index (BMI) between 25 and 35 kg/m². Ability to safely participate in the exercise program and comply with study procedures.

Exclusion Criteria:

* Acute low back injury. History of spinal surgery. Neurological disorders affecting movement or balance. Musculoskeletal disorders affecting movement or balance. Professional athletes. Individuals engaged in heavy manual labor. Any medical condition that would prevent safe participation in the intervention program.